Provider Demographics
NPI:1194812537
Name:MULLANEY, CHRISTINE M (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4071
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-4071
Mailing Address - Country:US
Mailing Address - Phone:732-576-1500
Mailing Address - Fax:732-576-1542
Practice Address - Street 1:127 MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2621
Practice Address - Country:US
Practice Address - Phone:732-970-4974
Practice Address - Fax:732-576-1542
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00990000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097905U20Medicare PIN